2018-2019 EACMSI Upper Level and Ithaca Youth Bureau (IYB) Basketball
This year we will offer two options for basketball participation: Club Basketball and Team Basketball. Student athletes must participate in Club Basketball to be on the Team Basketball.

The purpose of Club Basketball (November-December) is to offer students an opportunity to learn the sport of basketball and to have fun together. The participation fee for Club Basketball is $45.

The purpose of Team Basketball (January-March) is to continue learning the game of basketball, to participate on our school team, to play an interscholastic sport with other teams, and to have fun together. The participation fee for Team Basketball is $120.

Coaches
Julie Schaeffer - UL teacher, EACMSI basketball coordinator
Becky Robinson - current EACMSI board member, former EACMSI parent, IC crew coach
Scott Daigler - retired Junior Level teacher, currently supporting Upper Level and After School teacher
Tracy Smith - EACMSI after school and support staff, former collegiate basketball player
Stephen Lenhart - EACMSI Middle School teacher

If you have questions, please contact the basketball coordinator and UL teacher, Julie, at jschaeffer@eacmsi.org

This form is due by November 2nd, 2018 and and you will be billed via FACTS.

Last Name (student) *
Your answer
First Name (student) *
Your answer
Club/Team - practices begin the week of 11/5 *
T shirt size - for Team Bball only *
Student's Birthdate *
MM
/
DD
/
YYYY
Parent/Guardian Names *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian second email address (if you have one)
Your answer
Parent/Guardian phone numbers *
Your answer
Does your student need any special assistance to be able to participate in the basketball program? If so, please explain.
Your answer
Your answer
Residency Info - for Ithaca Youth Bureau. My child lives in the: *
Demographic Info - for Ithaca Youth Bureau (optional) My child identifies as:
I acknowledge that participation in the Elementary School Basketball program entails certain risks and dangers. I also understand that the presence of qualified instructors does not relieve participants of the responsibility for their own safety. I agree to exercise caution and good judgment in the program. Note: this is not to be interpreted as a waiver of participants' legal rights. I give permission for the Ithaca Youth Bureau to use photos/video/name of my child to promote community awareness. (if not please send a note to the program coordinator saying this). *
Required
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